By Charles Belot.
(Concluded from page 165).
It is at the moment even, of this remission, that sulphate of quinine must be administered in a dose of thirty-six grains taken at once in a half cup of black coffee without sugar. When the intermission is complete, its action is marvellous, the disease is immediately moderated; but if there is no remission, it is necessary to be prudent, for sulphate of quinine, because of its powerful action, can do much harm, if it is not indicated. When the disease commences with chills, followed by abundant sweats after the emetic and purgative, there is assurance, that there will be another remission, and then the sulphate of quinine is preëminently the remedy. But when there are no chills in the commencement of the disease, when the prominent symptoms are heat and dryness of the skin, and the fever continues, the exacerbation will not be long delayed, and no propitious moment can be found to administer the anti-periodic.
In cases where sulphate of quinine cannot be employed, calomel is an excellent remedy, especially when in the absence of remission, the tongue shows itself humid, loaded, white, large, the gums engorged, the stools difficult, or when there is bilious diarrhœa. Under these circumstances, calomel taken in purgative doses every half hour, until the characteristic stools of this remedy appear. Very often, after the administration of calomel, remission of the fever and of the congestive symptoms takes place; the skin becomes moist, and sulphate of quinine, the effect of which will be more sure in proportion to the distinctness of the remission, may then be appropriately used. Its effect is assisted by oil and by emollient injections. If there was no chill in the commencement, aconite and tincture of digitalis will be pressed. These are ordinarily sufficient to bring the patient into full convalescence.
The action of calomel and of sulphate of quinine has led some medical men to employ these remedies, united in the same formula. I have never understood the effect expected from this, and my experience has not proved the result satisfactory. When one is fortunate enough to have determined an intermission, frictions of sulphate of quinine produce a good effect. Calomel is not indicated, when the disease following its course, the alterations of the coat of the stomach become more observable, the epigastric pain more violent. In this case recourse may be had to the treatment heretofore recommended.
We have seen already, that there are three kinds of black vomit—that formed by bile, that formed by decomposed blood, and finally, that which is a mixture of these substances. The most numerous cases of cure are those, in which the black substance is formed by bile, and in these bicarbonate of soda and nux vomica will ordinarily triumph. But if the black vomit is formed from decomposed blood, there is no treatment which can result in positive action.
When cerebral symptoms predominate, with delirium, restlessness, etc., recourse should be had to blisters, to compresses upon the forehead of cold water and of brandy with belladonna, and to the administration internally of calomel alone, or combined with opium. This combination is valuable—it calms the cerebral excitement. When the delirium is violent, it is dissipated or quieted by an infusion of valerian.
Hiccough may be arrested by compressing with the fingers the phrenic nerve on the level of the os hyoid. In other instances, it yields to the application of cold water on the stomach to opium, to belladonna in small doses, to ice swallowed in small pieces.
When hemorrhages occur, the most appropriate remedies are acids, astringents, and iron. Local, such as buccal hemorrhages, yield to lotions of diluted sulphuric acid every half hour, or to gargles of borax. The best means of resisting epistaxis is by application of ice to the forehead; at the same time, by acid injections into the nostrils. Plugging of the anterior openings of the nostrils would be insufficient, because the hemorrhage is passive, and comes from the whole surface of the nasal mucous membrane. For anal hemorrhages, acid injections, the application of cold to the abdomen, and tannin given internally, are prescribed.
General hemorrhage, that is to say decomposition of the blood, is combatted with tannin or perchloride of iron administered every two hours, with lotions of vinegar or of wine of cinchona, applied over the whole body.